新福洋子１）、Frida madeni２）、下田佳奈１） 1)聖路加国際大学、2)Magunga District Hospital 一般社団法人 日本国際保健医療学会 利益相反（ＣＯＩ）開示 新福洋子 演題発表に関連し、開示すべき利益相反 （ＣＯＩ）関係にある企業などはありません。 世界の妊産婦死亡率 アフリカでは400-500/100,000 (WHO, 2014) SDG Goal3 70/100,000 2016/12/6 3 母子保健指標: タンザニア • 妊産婦死亡率: 454/100,000 • SBAが介助する出産: 42.3% in rural areas REF: National Bureau of Statistics [NBS] Tanzania & ORC Macro, 2011 出産介助者 Doctor/AMO Clinical officer Nurse/Midwife MCH aide 57.7 TBA Relative/friend Other No one Don't know 4 目的 妊産婦の健康を促進する地域体制を強化するには、 TBAを含めた地域のステークホルダーが協力し、妊産 婦の安全を地域で支える必要がある。 妊産婦のケアにあ たるTBAの活動実態 と課題を記述し、妊 産婦の安全を守る 地域体制を考察す る。 方法 • 対象地区：タンザニア北東部の農村地区 • 対象：TBAとして活動している15名の女性 • データ収集：半構造的インタビュー • 言語：スワヒリ語 – – – – 現在の活動概要 活動に必要な資源 活動の困難 活動への認識 • 英語に翻訳し、内 容分析 結果：背景データ • • • • 年齢：平均59.5歳（40~73歳） 教育レベル：小学校4年生まで～小学校卒業まで TBA以外の職：農民(10)、議会員(1)、元看護師(1) 宗教：キリスト教 Background of TBA work Themes Categories Becoming TBA Outsider-driven Family-driven Reason to deliver at home Condition of births Agreement among family members Sub categories Trained in the seminar From grandmother or mother Baby’s head was coming out Her mother in law does not allow her to go to hospital Work of TBA Our work is to advice women Normal procedure Abnormal case Use available materials Basic hygiene (old TBA) Importance of going to hospital Nutrition & Exercise Vaccination Check the mother and the baby Support not to tear Deliver baby Cut the cord and placenta Check bleeding after delivery Breastfeed the baby Bring hospital for obstructed labor Clothes to wrap babies Gloves Plastic and linen bed cover Blade and bandage to cut the code Brush to wash hands Proper knowledge • “There is no baby that I delivered with bad condition but if that happened I should take the baby to the hospital immediately, there was a time I delivered twins babies and I delivered two mothers but all were baby boys with good conditions.” • “I assisted the mother whose placenta failed to come out so I took her to the hospital. I tried to put my hands on mother’s umbilical cord so that the placenta could come out, but if difficult to remove she should go the hospital for removal.” Family and Rewards Family role Preparation for delivery Materials for delivery Money TBA rewards Support during delivery Give by family Soup and food Positive perception toward job I feel good about my job A small amount of money Physical supply Happiness of being a TBA • “I feel good being traditional birth attendants, I get skills and I also provide close and good service, it is like the first aid service.” • “Many mothers come to me for advice. I feel happy to help my fellow women. There are no challenges. My happiness is when the mother is safe, I become so happy.” Issues surrounding TBA Lack of resources Relationship with hospital Relationship with hospital Need of TBA Materials are not given Money is not given Unfavorable outcome Training for normal delivery procedure Interaction with one another Materials Told them to stay outside Lack of opportunities for working/studying together Maternal death Cervix dilation Times for delivery Delivery Injection to stop bleeding Special blade For youth Gloves Plastic bed cover Fetoscope • “There is no cooperation with health personnel at all, when we go to the hospital they chase us out.” • “Our fellow from the hospital do not call us to their activities, we want to learn because when the mother is sick we don’t know any signs if is written on the antenatal cards.” • “When I transfer to the hospital, she[mother] does not give me anything. She can give me money or gift only if I can conduct delivery at home.” • “Sometimes I am given gift like money, I use it to buy other materials (such as gloves).” 考察 • 2001年まで医療施設で行われていたトレーニン グを受けたTBAであり、初産婦や6人目以降の経 産婦は受けないようにしていること、基本的な分 娩技術、搬送の基準についての知識は正しかっ た。 • しかし、現在教育がされていないことで、知識の アップデートができないこと、若手を育成でき ないこと、資材のサポートを受けられないこと、 病院のスタッフとの連携がされず、妊婦を連れて 行くと追い出されることが課題であった。 結論 TBAはODAからの支援が途切れた現在も妊産 婦の健康に大きく貢献している。妊産婦のより 安全な出産のためにも、施設との連携を強め、 資材や資金の提供と良好な関係性による効率 的な搬送が求められる。 謝辞 本研究はJSPS科研費 JP26861940、JSPS研究拠 点形成事業の助成を受けたものです。
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